Provider Demographics
NPI:1598890162
Name:COLE, ELISE M (LCSW)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:M
Last Name:COLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 MARLBORO RD
Mailing Address - Street 2:
Mailing Address - City:WOOD RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07075-1226
Mailing Address - Country:US
Mailing Address - Phone:201-939-5059
Mailing Address - Fax:201-939-5059
Practice Address - Street 1:186 PATERSON AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:EAST RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07073-1837
Practice Address - Country:US
Practice Address - Phone:201-939-3509
Practice Address - Fax:201-939-5059
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC048388001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical